Solitary Fibrous Tumours in the Central Nervous System and Their Clinical Mimickers: A Case Series

Solitary fibrous tumours (SFT) of the central nervous system (CNS) are rare mesenchymal neoplasms. Challenges arise at the time of diagnosis due to their overlapping clinical, radiological, and histopathological features with other spindle cell tumours. We present four cases of SFTs arising at different anatomical locations across the CNS. The patients presented with varied clinical symptoms and radiological findings, leading to an initial diagnosis of other mimickers, such as fibrous meningioma, neurofibroma, and other spindle cell tumours. Histopathological examination revealed tumours composed of spindle cells and branching, staghorn-like vasculature. Immunohistochemical evaluation with STAT6 was performed in all the cases to distinguish SFT from its histological mimickers. It demonstrated diffuse nuclear staining of tumour cells in all four cases. Based on the histology, mitotic activity, and necrosis, the tumours were classified as CNS WHO Grades 1, 2, and 3. These cases highlight the varied clinical and radiological presentations of CNS SFTs. They also emphasise the importance of careful histopathological assessment with appropriate immunohistochemical workup for accurate diagnosis. Awareness of this entity and its mimickers is essential to avoid misdiagnosis and ensure appropriate patient management.